Systematic Review Finds No Increased Risk to Fetus After Parental Exposure to Biologics for Psoriasis

While biologic treatment forms an important part of the treatment paradigm for psoriasis, limited evaluation of biologics’ safety in conception or during pregnancy is available. During a recent meeting of the British Association of Dermatologists, a team of researchers from the United Kingdom reported on a systematic review of literature on adults exposed to biologics during conception and/or pregnancy, and they report that they did not find increased risk to the fetus following maternal or paternal biologic exposure.

The investigators considered data from 8 population-based cohort studies including 3600 women who, from 1995 to 2018, were exposed to anti—tumor necrosis factor (anti-TNF) therapies during conception or the first 3 months of pregnancy. One study comprised exclusively women with psoriasis, while others included women with other inflammatory diseases.

None of the studies showed clear evidence of drug-specific harm to the fetus following anti-TNF exposure with respect to congenital malformation (6 studies), live births (3 studies), preterm birth (4 studies), or neonatal infection (1 study). One study addressed maternal infection, and showed a potential increased risk to the mother following anti-TNF exposure (odds ratio, 1.49; 95% CI, 1.31-1.69).

In men, there was 1 cohort study available, and it included 391 men with inflammatory diseases, including psoriasis, who were exposed to an anti-TNF agent during conception. The study found no increase in congenital malformations, preterm births, or infants who were small for their gestational age.

No studies were identified for interleukin inhibitors, or for p19 antagonists, however, and the investigators note that there are gaps in evidence regarding the effects of biologic therapy related to the risk to the mother and the infant in the longer term.

However, the authors concluded that there was no observed increased risk to the fetus following a parent’s exposure to an anti-TNF during conception or pregnancy. They added that, when counseling patients considering a pregnancy, any uncertainty related to the risks that biologics may pose should be weighed against the potential impact of uncontrolled psoriasis on the parent or on the conception and/or pregnancy outcome.

Reference

Woolf R, Exton L, Owen C, Nelson-Piercy C, Smith C. The impact of exposure to biological therapies for psoriasis during conception and pregnancy: a systematic review. Presented at: British Association of Dermatologists’ 99th Annual Meeting; July 2-4, 2019; Liverpool, United Kingdom. Abstract P091.